Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Obesity and Metabolic Surgery, Sana-Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
Obes Surg. 2021 Apr;31(4):1422-1430. doi: 10.1007/s11695-020-05153-4. Epub 2021 Jan 6.
The augmentation of hiatoplasty (HP) with the ligamentum teres hepatis (LTA) is a new concept for intrathoracic migration of a gastric sleeve or pouch (ITGM). We retrospectively analyzed all cases of hiatal hernia repair in a single center between 2015 and 2019.
A total of 171 patients underwent 307 hiatal hernia repairs after sleeve gastrectomy (SG) (n = 79), Roux-en-Y gastric bypass (RYGB) (n = 129), and one anastomosis gastric bypass (OAGB) (n = 99). Each hiatal hernia repair was defined as a "case" and assigned to the LTA group or the non-LTA group. The primary outcome was the recurrence of ITGM as detected by endoscopy or CT.
The basic characteristics in the LTA group (78 cases) and the non-LTA group (229 cases) were comparable with the exception of the rate of revisional HP (72% vs. 21%), the rate of prior conversion to RYGB (33% vs. 17%), the initial BMI (45.9 ± 8.2 kg/m vs. 49.0 ± 8.8 kg/m), and the follow-up (7 months (1-16) vs. 8 months (1-54)). The ITGM recurrence rate was 15% in the LTA group and 72% in non-LTA group (p < 0.001). Multivariate analysis showed that the length of ITGM and the type of surgical repair were independent risk factors. The addition of LTA to HP lowered the probability of ITGM recurrence by a factor of 0.35 (p = 0.015), but the conversion from SG or OAGB to RYGB did not reduce the risk.
LTA reduces the risk of early ITGM recurrence. The long-term durability, however, needs to be further investigated.
通过横膈韧带（LTA）增强横膈切开术（HP）是胃袖套或袋（ITGM）向胸腔内迁移的新概念。我们回顾性分析了 2015 年至 2019 年期间在一个中心进行的所有食管裂孔疝修复病例。
共有 171 例患者在袖状胃切除术（SG）后（n=79）、Roux-en-Y 胃旁路术（RYGB）后（n=129）和一次吻合胃旁路术（OAGB）后（n=99）进行了 307 例食管裂孔疝修复。每个食管裂孔疝修复被定义为一个“病例”，并被分配到 LTA 组或非 LTA 组。主要结果是通过内窥镜或 CT 检测到 ITGM 的复发。
LTA 组（78 例）和非 LTA 组（229 例）的基本特征具有可比性，除了修正性 HP 的发生率（72% vs. 21%）、先前转换为 RYGB 的发生率（33% vs. 17%）、初始 BMI（45.9±8.2 kg/m vs. 49.0±8.8 kg/m）和随访（7 个月（1-16） vs. 8 个月（1-54））。LTA 组的 ITGM 复发率为 15%，非 LTA 组为 72%（p<0.001）。多变量分析显示，ITGM 的长度和手术修复类型是独立的危险因素。HP 中添加 LTA 将 ITGM 复发的概率降低了 0.35 倍（p=0.015），但从 SG 或 OAGB 转换为 RYGB 并不能降低风险。
LTA 降低了早期 ITGM 复发的风险。然而，需要进一步研究其长期耐久性。
